Graphomotor Fluency in Child and Adolescent ADHD

210 Pages·2017·2.16 MB·English

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Electronic Theses and Dissertations Theses, Dissertations, and Major Papers
2016
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Thomas Anthony Duda
University of Windsor
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Duda, Thomas Anthony, "Graphomotor Fluency in Child and Adolescent ADHD: Neuropsychological
Factors and Implications for Assessment" (2016). Electronic Theses and Dissertations. 5816.
https://scholar.uwindsor.ca/etd/5816
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GRAPHOMOTOR FLUENCY IN CHILD AND ADOLESCENT ADHD:
NEUROPSYCHOLOGICAL FACTORS AND IMPLICATIONS FOR ASSESSMENT

by

Thomas A. Duda

A Dissertation
Submitted to the Faculty of Graduate Studies
through the Department of Psychology
in Partial Fulfillment of the Requirements for
the Degree of Doctor of Philosophy
at the University of Windsor

Windsor, Ontario, Canada
2016

© 2016 Thomas A. Duda
GRAPHOMOTOR FLUENCY IN CHILD AND ADOLESCENT ADHD:
NEUROPSYCHOLOGICAL FACTORS AND IMPLICATIONS FOR ASSESSMENT

By

Thomas A. Duda

APPROVED BY:

______________________________________________
O. Tucha, External Examiner
University of Groningen, The Netherlands

______________________________________________
N. McNevin
Department of Kinesiology

______________________________________________
C. Abeare
Department of Psychology

______________________________________________
K. Cramer
Department of Psychology

______________________________________________
J. E. Casey, Advisor
Department of Psychology

June 23, 2016
Declaration of Originality

I hereby certify that I am the sole author of this dissertation and that no part
of this dissertation has been published or submitted for publication.
I certify that, to the best of my knowledge, my dissertation does not infringe
upon anyone’s copyright nor violate any proprietary rights and that any ideas,
techniques, quotations, or any other material from the work of other people included
in my dissertation, published or otherwise, are fully acknowledged in accordance
with the standard referencing practices. Furthermore, to the extent that I have
included copyrighted material that surpasses the bounds of fair dealing within the
meaning of the Canada Copyright Act, I certify that I have obtained a written
permission from the copyright owner(s) to include such material(s) in my
dissertation and have included copies of such copyright clearances to my appendix.
I declare that this is a true copy of my dissertation, including any final
revisions, as approved by my dissertation committee and the Graduate Studies
office, and that this dissertation has not been submitted for a higher degree to any
other University or Institution.

iii
Abstract
Attention-Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental
disorder of complex etiology that typically presents behaviourally with symptoms
of inattention, hyperactivity, and impulsivity. Among associated features,
executive dysfunction, learning difficulties, and motor problems are common of
the disorder. The present study involved two parts, where Part I sought to
determine the optimal methodology to be used for Part II. Within the context of
childhood ADHD, Part II of the study investigated 1) the effects of cognitive
control on kinematic graphomotor fluency, 2) whether graphomotor fluency
development is attenuated in children with ADHD, 3) which neuropsychological
factors would best predict improvement in graphomotor fluency, and 4) the
predictive ability of graphomotor improvement in identifying ADHD. Results
indicated the following: 1) participants with and without ADHD demonstrated
similar graphomotor fluency as cognitive control demands and figural complexity
increased, 2) participants with ADHD evidenced attenuated procedural learning
relative to controls when learning a novel grapheme, 3) the neuropsychological
factors of verbal skills, processing speed, and fine motor skills were not predictive
of improvement in graphomotor fluency, and 4) change in graphomotor fluency
improvement did not demonstrate adequate ability to differentiate between those
with and without ADHD. Implications, limitations, and additional considerations
are discussed.

iv
Dedication
To my wife, Laura, my family, and my friends. Thank you for your
patience and support. I could not have completed this without each of you.

v
Acknowledgements
The successful completion of this document would not have been possible
without the support of several key individuals. I would like to thank Amanda
O’Brien, Natalie Frost, Amanda Phillips, Judy Truong, and Erin Kelly for their
selfless work and diligence scheduling participants and collecting data while I was
in Texas on internship. I am forever grateful. I would also like to thank my
supervisor, Dr. Joseph Casey, for his advice, feedback, and guidance in managing
this complex project, and my dissertation committee members, Drs. Christopher
Abeare, Kenneth Cramer, Nancy McNevin, and Oliver Tucha, for all of their input
and support throughout this process.
Thank you as well to my fellow graduate students, interns, and supervisors
at Texas Children’s Hospital, who have provided emotional support as well as
professional guidance as I navigated internship while completing my dissertation.
Finally, and most importantly, I thank my family – especially my wife Laura – for
all of their patience and support throughout the past six years. I would not have
been able to pursue and successfully complete my doctoral training without them.

vi
Table of Contents
Declaration of Originality ........................................................................................ iii
Abstract .................................................................................................................... iv
Dedication ................................................................................................................. v
Acknowledgements .................................................................................................. vi
List of Tables ........................................................................................................... xi
List of Figures ........................................................................................................ xiii
List of Appendices ................................................................................................. xiv
List of Abbreviations .............................................................................................. xv
Chapter 1: Introduction ............................................................................................. 1
ADHD: Epidemiology, Course, and Outcome ................................................. 2
Etiology ............................................................................................................. 6
Genetics and Neurotransmitter Systems ...................................................... 6
Structural Neuroimaging Findings ............................................................... 8
Functional Neuroimaging Findings ........................................................... 10
Neural Networks Underlying ADHD ........................................................ 12
Neuropsychological Functioning .................................................................... 15
Executive Functioning and Cognitive Control ............................................... 16
Learning and ADHD ....................................................................................... 18
Motor Functioning .......................................................................................... 21
Handwriting in ADHD and Kinematic Analysis ....................................... 23
Interrelationships between EF, Learning, and Motor Functioning ................. 28
Diagnostic Criteria and Assessment of ADHD .............................................. 30
vii
The Present Study and Hypotheses ................................................................. 37
Hypotheses: Part II, Study 2 ...................................................................... 38
Hypotheses: Part II, Study 3 ...................................................................... 38
Hypotheses: Part II, Study 4 ...................................................................... 39
Hypotheses: Part II, Study 5 ...................................................................... 39
Chapter 2: Method – Part I, Study 1 ....................................................................... 41
Participants ...................................................................................................... 41
Materials and Apparatus ................................................................................. 41
Procedure ........................................................................................................ 45
Chapter 3: Results – Part I, Study 1 ........................................................................ 49
Analysis of Assumptions and Data Cleaning.................................................. 50
Participant Descriptive Information ................................................................ 54
Analysis of Order Set Effects ......................................................................... 56
Primary Data Analyses ................................................................................... 57
Chapter 4: Discussion – Part I, Study 1 .................................................................. 59
Chapter 5: Method – Part II, Studies 2, 3, 4, and 5 ................................................. 62
Participants ...................................................................................................... 62
Materials and Apparatus ................................................................................. 64
Demographic, Sleep, and Neuropsychological Assessment ...................... 64
Handwriting Analysis ................................................................................ 69
Procedures ....................................................................................................... 69
Research Assistants .................................................................................... 69
Eligibility, Interview, and Parent-Report Measures .................................. 69
viii
Group Assignment ..................................................................................... 72
Neuropsychological Assessment and Handwriting Tasks ......................... 73
Error Validation ......................................................................................... 79
Chapter 6: Results and Discussion – Part II, Studies 2, 3, 4, and 5 ........................ 79
Data Cleaning Prior to Statistical Analyses .................................................... 80
Initial Participant Data Removal ..................................................................... 84
Participant Descriptive Information ................................................................ 84
Identification of Potential Covariates ............................................................. 90
Results – Study 2 ............................................................................................ 91
Analysis of Assumptions ........................................................................... 91
Primary Data Analysis ............................................................................... 93
Supplementary Data Analyses ................................................................... 97
Discussion – Study 2 ....................................................................................... 97
Results – Study 3 .......................................................................................... 103
Analysis of Assumptions ......................................................................... 104
Primary Data Analysis ............................................................................. 105
Discussion – Study 3 ..................................................................................... 108
Results – Study 4 .......................................................................................... 115
Discussion – Study 4 ..................................................................................... 116
Results – Study 5 .......................................................................................... 120
Discussion – Study 5 ..................................................................................... 122
Chapter 7: Summary of Major Findings ............................................................... 124
References ............................................................................................................. 126
ix